Lack of Sexual Identity Disclosure in China May Distort Efforts to Combat STI Epidemics

Background. To evaluate whether Chinese men who have sex with men (MSM) select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive role in anal sex). Methods. We studied uptake of gonorrhea and chlamydia testing among Chinese MSM (N=431) in a multi-site RCT (December 2018 to January 2019). We collected socio-demographics, relevant medical and sexual history, and disclosure of sexual identity (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision-making. Results. Among 431 MSM, mean age was 28 years (SD=7.10) and 65% were out to someone. MSM who indicated the versatile role and were out to someone had a 26.8% (95%CI=6.1, 47.5) increased likelihood for selecting the rectal test vs the urethral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI=6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. Conclusions. Anal sex role and identity disclosure may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community-based efforts may reduce stigma-based barriers to testing.